Bệnh lý viêm tụy

PGS. TS. HA VAN QUYET JGUYEN c l ie u NHA XU A T BAN Y HOC HA VAN QUYET BEI\H LY VIEM THY • • (Sack chuyen khao dung cho sau Dai hoc) f 1 NHA XUAT BAN Y HOC HA NOI - 2006 LOI Gldl THIEU Nhutng nam gan day viem tuy la mot benh ly thifdng gap do nhieu nguyen nhan nhii soi mat, soi tuy, giun chui ong mat NhUng cung khong it cac tnidng hdp viem tuy do che do an uong thay doi nhiJ uong rutdu nhieu hon, nhieu chat dinh dtfdng hdn Mot thay doi niia la sii hieu biet ve cd che benh ly, cac bieu hien lam sang dac biet la cac phiidng phap chan doan nhif sieu am, chup CT, cong hiidng tCf da xac dinh r5 cac nguyen nhan cua viem tuy tvt do co nhOfng chi dinh dieu tri thich hop. Cung v6i nhCing kinh nghiem cua phau thuat kinh dien de dieu tri viem tuy, chung ta da co nhiing phifOng tien m6i nhu phau thuat noi soi va noi soi can thiep de ap dung trong dieu tri nhiing triidng hdp viem tuy cap do nguyen nhan cd hoc, lam thay doi quan niem ve viem tuy va ket qua dieu tri ngay cang tot hon. Hy vong quyen sach “Benh ly viem tuy” cua PGS.TS. Ha Van Quyet se giup trang bi them cho doc gia mot so" thong tin, kien thilc va kinh nghiem trong chan doan va dieu tri viem tuy cap va man tinh. g s . n g u y I n b u u tr ie u 3 LOI NOI DAU Trong thdi gian gan day viem tuy la mot benh ly co xu hiidng tang cao va nang ne hdn. Co hai loai viem tuy: viem tuy cap (VTC) va viem tuy man (VTM). Moi mot loai viem tuy co dac diem ton thiidng, nguyen nhan, cd che, trieu chting lam sang khac nhau nen thai do dieu tri, cung nhii phvfdng phap dieu tri khac nhau. Benh ly viem tuy g&n day difdc chu y nhieu bdi so liidng benh nhan ngay cang tang, kha nang chan doan bang tham do can lam sang nhii xet nghiem, sieu am, chup cat 16p vi tinh (CT.Scanner), chup cong hiidng tu: (CHT), sieu am noi soi (Sono Endoscopy) da diidc thiia nhan.Vdi cac tham do nay da phat hien diidc nhieu thiidng ton, nguyen nhan de co nhiing phtfdng phap dieu tri noi khoa va phau thuat hieu qua, tranh de lai nhiing bien chufng va di chiing nang ne cua benh nhan sau phau thuat viem tuy. Mat khac, khi hieu biet ro cd che va nguyen nhan cua viem tuy co the de ra cac bien phap phong ngtia nhu dieu chinh che do an uong, han che uong riidu, chat beo, de phong cac tac nhan gay viem tuy nhif tay giun, phat hien s6m cac loai soi mat, soi tuy, roi loan co that Xac dinh chan doan sdm khi phat hien cac trieu chtfng cua viem tuy cap trong cong dong la mot yeu to' de dieu tri kip thdi, tranh dan den tinh trang huy hoai to chiic tuy, hinh thanh cac o hoai tvi trong to ch ic tuy, to ch\ic xung quanh tuy, cac khoang trong o bung, chay doc theo r§ mac treo , dong lai d ho chau phai co khi tao thanh nhiing ’’dong to chiic hoai tii “ len ca dudi vom hoanh, co khi ca khoang mang phoi, ca trung that. Con doi vdi viem tuy man co the d^n den chit t i c ong tuy (Wirsung), nang tuy hay soi tuy, neu khong dieu tri s6m se co nhiing bien chiing nang nhuf ddt cap cua viem tuy, nang tuy, xd hoa tuy, ap xe tuy va bien chilng khac nhut viem phuc mac, roi loan toan than, chay mau tieu hoa Tac gia hy vong 4 quyen sach nho nay cung cap them cho cac ban doc mot so kien thiic va thong tin ve benh ly viem tuy, qua do gop phan nang cao kha nang chan doan va dieu tri tot hdn loai benh ly nang ne nay. De hoan thanh quyen sach nay xin chan thanh cam dn stf cong tac tich ciic cua Bac sy Pham Tien Dat va Bac sy Le Manh CUdng cung Nha xuat ban Y hoc da giup dd in an. Quyen sach nay se khong tranh khoi nhiing sai sot, rat mong cac doc gia thong cam va dong gop y kien de cho hoan thien hdn. Xin tran trong cam dn. PGS.TS. HA VAN QUYET Chu nhiem Bo mon ngoai Dai hoc Y Ha Noi PGO Benh vien Viet Bure 5 MUC LUC Phan I. GIAI PHAU BENH LY 9 1. Giai phau tuy. 9 2. Hinh anh to ch\ic hoc cua tuy. 15 Phan II. SINH LY TUYEN TUY 17 1. Chtfc nang noi tiet: 17 2.Chile nang ngoai tiet: 18 3. Su bai tiet dich tuy: 19 4. Sii bai tiet cac chat ilc che Trypsin 21 5. Su bai tiet ion H C 03 va niidc: 21 6. Dieu hoa bai tiet dich tuy: 22 Phan III. VIEM TUY CAP 25 1. Lich sii benh viem tuy cap 27 2. Nguyen nhan gay viem tuy cap 32 3. Cd che benh sinh cua viem tuy cap. 33 4. Benh hoc va sinh ly benh cua viem tuy cap. 35 5. Giai phau benh viem tuy cap. 37 6. Phan loai 39 7. Trieu chting va chan doan. 40 8. Bien chilng cua viem tuy cap 51 7 9. Tien liidng viem tuy cap. 53 10. Dieu tri viem tuy cap 58 11 .K etlu an 68 Phan IV. VIEM TUY MAN VA SOI TUY 71 1. Nguyen nhan gay viem tuy man 72 2. Phan loai viem tuy man 75 3. Chan doan 75 4. Dieu tri 89 8 PHAN I s a Lirac g ia i p h au 1. GIAI PHAU TUY 1.1.V| tri va hinh the ngoai cua tuy [4,6,7] Tuy di tif khuc II ta trang tcii ron lach, nam vat ngang, sat triidc cot song liing, chech len tren, sang trai, phan 16n d tang tren mac treo dai trang ngang va mot phan nho d tang diidi. Kich thiiclc tuy co the thay doi rat nhieu tuy theo tin g ngiidi va chieu dai thay doi tu: 16-20 cm, tuy co hinh chi3 S hay trong giong nhii mot cai bua det theo chieu tru6c sau va 2 do cong lom ra sau de om lay cot song va lom ra trUdc de om lay da day, trong liidng trung binh tii 70 - 80 gram, to chiic tuy rat mem co mau trang nga. Cung v6i phan xuong cua ta trang, dau tuy co lien quan phla sau v6i cot song liing LI - LII, mat tru6c than tuy lom ap sat vao mat sau da day va diidc phu bdi phuc mac thanh sau cua hau cung mac noi, mat sau phang dinh vao thanh sau phuc mac di tu! phai sang trai va bat cheo dong mach chu bung. Bd tren than tuy co dong mach lach chay qua, bd dii6i thi d phia sau mac treo dai trang ngang. Tuy la tuyen thuoc bo may tieu hoa viia noi tiet vita ngoai tiet. 9 Hinh 1.1: Vi tri va hinh the ngoai Tuy nam sau phuc mac, di tit phan xuong ta trang den cuong lach nam vat ngang trifdc cot song that liing tti Lj den L3 len tren sang trai, phan ldn tuy nam d tang tren mac treo dai trang ngang, mot phan nho d difdi mac treo dai trang ngang. Tuy co hinh giong nhii chiec bua det, v6i hai mat cong lom. lom ra sau de ora lay cot song va lom ra triidc de om lav mat sau da day, tuy co hai mat: tru’dc, sau, hai bd: tren, difcii, trong lu'o'ng trung binh tii 70 - 80 gam, to chilc tuy rat mem co mau trang nga. Tuy dUdc chia lam 4 phan: Dau tuy hinh vuong co ta trang bao quanh, phia dudi dau tuy co moc tuy con goi la eo tuy. - Dau tuy: Day 3cm, cao 7cm, dai 4cm, det, gan hinh vuong, dai 4cm, cao 7cm, day 3cm, co ta trang bao quanh 10 - Phi'a difdi dau tuy co moc tuy. Giiia dau tuy va than tuy co khuyet tuy hay con goi la eo tuy. - Than tuy: tif khuyet tuy chech len tren sang trai, dai 10cm, cao 4cm, day 3cm, co ba mat: TrU6c - Sau - Du6i, co ba bd: Tren - Dudi - TrUdc - Duoi tuy: tiep theo than tuy, duoi co the dai hay ngan tron hay det, phi'a tren va trUdc duoi tuy co dong mach lach chay qua, duoi tuy dai ngan tuy theo tCfng ca the, di dong trong mac noi tuy- lach. (13) 1.2. Cac ong tiet cua tuy Tuy la tuyen vifa noi tiet v ia ngoai tiet: - Noi tiet: tiet ra insulin, glucagon di thang vao mau, qua cac mao mach trong tuyen - Ngoai tiet: dich tuy tiet ra tu! cac ong tiet lien tieu thuy, roi do vao cac ong tiet ldn. Dich tuy dUOc bai tiet qua hai ong tiet chi'nh do la ong tuy chinh: (ong Wirsung), ong tuy phu: (ong santorini). ong tuy chinh: chay theo true tuy doc t\f duoi tuy den than tuy hoac hoi chech len mot chut, (xem hinhl.2): dang trong giong nhu mot la cay. Ong tuy chinh Ong mat chu Hinh1.2. Ong tuy chinh va ong mat chu 11